Healthcare Provider Details

I. General information

NPI: 1720249162
Provider Name (Legal Business Name): WENDY A. WAGUESPACK, O.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7932 PICARDY AVE STE A
BATON ROUGE LA
70809-3741
US

IV. Provider business mailing address

7932 PICARDY AVE STE A
BATON ROUGE LA
70809-3741
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-8435
  • Fax: 225-767-9493
Mailing address:
  • Phone: 225-767-8435
  • Fax: 225-767-9493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number874-019T
License Number StateLA

VIII. Authorized Official

Name: DR. WENDY A. WAGUESPACK
Title or Position: DR.
Credential: O.D.
Phone: 225-767-8495